Prosthetic Atrioventricular Valve with Large Waist

Abstract

A prosthetic heart valve may include a collapsible and expandable frame that includes an atrial anchor, a ventricular anchor, and a center waist extending therebetween. The frame may include a plurality of commissure attachment features (“CAFs”) that include struts that extend from the center waist. A plurality of prosthetic leaflets may be mounted to the plurality of CAFs. A sealing fabric may be coupled to an outer surface of the frame. When the valve is expanded, the atrial and ventricular anchors each flare outwardly from the center waist, which defines a waist diameter of the frame. When expanded, each of the CAFs may be spaced from each other so that gaps in the frame are present therebetween. When expanded, the CAFs may be positioned along an imaginary circle having a diameter that is smaller than the waist diameter.

1 . A prosthetic heart valve for replacing a native atrioventricular valve, the prosthetic heart valve comprising:
 a collapsible and expandable frame, the frame including an atrial anchor, a ventricular anchor, and a center waist extending between the atrial anchor and the ventricular anchor, the frame including a plurality of commissure attachment features (“CAFs”) that include struts that extend from the center waist;   a plurality of prosthetic leaflets mounted to the plurality of CAFs; and   a sealing fabric coupled to an outer surface of the frame;   wherein in an expanded condition of the prosthetic heart valve, the atrial anchor and the ventricular anchor each flare outwardly from the center waist, the center waist defining a waist diameter of the frame,   wherein in the expanded condition of the prosthetic heart valve, each of the plurality of CAFs is spaced from adjacent ones of the plurality of CAFs so that gaps in the frame are present between adjacent ones of the plurality of CAFs; and   wherein in the expanded condition of the prosthetic heart valve, the CAFs are positioned along an imaginary circle having a diameter that is smaller than the waist diameter.   
     
     
         2 . The prosthetic heart valve of  claim 1 , wherein in the expanded condition of the prosthetic heart valve, the waist diameter is about 40 mm. 
     
     
         3 . The prosthetic heart valve of  claim 2 , wherein in a collapsed condition of the prosthetic heart valve, the prosthetic heart valve has an axial height between an inflow end of the prosthetic heart valve and an outflow end of the prosthetic heart valve, the axial height being between about 48 mm and about 58 mm. 
     
     
         4 . The prosthetic heart valve of  claim 1 , further comprising:
 a commissure support ring coupled to and extending around the plurality of CAFs.   
     
     
         5 . The prosthetic heart valve of  claim 4 , wherein the commissure support ring is a collapsible and expandable structure that has a circular or lobed shape in an expanded condition of the commissure support ring. 
     
     
         6 . The prosthetic heart valve of  claim 4 , wherein the commissure support ring includes a first circumferential row of generally diamond-shaped cells. 
     
     
         7 . The prosthetic heart valve of  claim 6 , wherein the commissure support ring includes a second circumferential row of generally diamond-shaped cells adjacent the first circumferential row. 
     
     
         8 . The prosthetic heart valve of  claim 7 , wherein the commissure support ring includes a plurality of connectors integrally formed with the commissure support ring, the plurality of connectors each having a shape that is complementary to a shape of each of the plurality of CAFs. 
     
     
         9 . The prosthetic heart valve of  claim 1 , wherein the frame includes a plurality of tines on the ventricular anchor, each of the plurality of tines extending to a free end pointing toward the atrial anchor in a collapsed condition of the prosthetic heart valve. 
     
     
         10 . The prosthetic heart valve of  claim 1 , wherein in the expanded condition of the prosthetic heart valve, the ventricular anchor of the frame is bell-shaped. 
     
     
         11 . The prosthetic heart valve of  claim 10 , wherein the sealing fabric extends over the ventricular anchor and over the center waist of the frame, an inflow edge of the sealing fabric being positioned a spaced distance from a terminal end of the atrial anchor. 
     
     
         12 . The prosthetic heart valve of  claim 1 , wherein, in the expanded condition of the prosthetic heart valve, the struts that couple the plurality of CAFs to the center waist include a first contour extending in an outflow and radially inward direction, and a second contour extending in an outflow and radially outward direction, the plurality of CAFs being coupled to the second contour of respective ones of the struts. 
     
     
         13 . The prosthetic heart valve of  claim 12 , wherein, in the expanded condition of the prosthetic heart valve, the plurality of CAFs each extend in a direction substantially parallel to a center longitudinal axis of the prosthetic heart valve. 
     
     
         14 . The prosthetic heart valve of  claim 13 , wherein in the expanded condition of the prosthetic heart valve, the diameter of the imaginary circle is about 29 mm. 
     
     
         15 . The prosthetic heart valve of  claim 1 , wherein each of the plurality of prosthetic leaflets includes an attached edge, a free edge opposite the attached edge, and two side edges extending between the free edge and the attached edge. 
     
     
         16 . The prosthetic heart valve of  claim 15 , further comprising:
 an atrial skirt attached to an interior surface of the frame, the atrial skirt having an inflow edge attached to the atrial anchor, and a plurality of contoured sections, each of the plurality of contoured sections attached to a respective one of the attached edge of the plurality of prosthetic leaflets.   
     
     
         17 . The prosthetic heart valve of  claim 16 , wherein the atrial skirt is formed of a material that is non-permeable to blood. 
     
     
         18 . The prosthetic heart valve of  claim 17 , wherein the material is a woven polyester. 
     
     
         19 . The prosthetic heart valve of  claim 17 , wherein the atrial skirt is coupled to the sealing skirt. 
     
     
         20 . The prosthetic heart valve of  claim 17 , wherein the atrial skirt includes a plurality of extensions, each of the plurality of extensions being positioned between a respective one of the plurality of CAFs and a respective commissure of the plurality of prosthetic leaflets, each commissure being formed by an attachment of one of the two side edges of one of the plurality of prosthetic leaflets with one of the two side edges of an adjacent one of the plurality prosthetic leaflets.